2017 CMS Annual Meeting - Health care reform

Wednesday, November 01, 2017 12:16 PM

Speakers examine health reform efforts underway

by Kate Alfano, CMS Communications Coordinator

Three intriguing presentations during the 2017 CMS Annual Meeting dove into the multifaceted issue of health reform, outlining action happening on the state level, federal level and in the health system overall.

The first, the opening talk of the meeting, was “What the Heck Just Happened? Health Policy Beyond 2017 (We WILL Get Through This!)” with speaker Len Nichols, PhD, director of the Center for Health Policy Research and Ethics and a professor of Health Policy at George Mason University.

“Everybody in Washington agrees that the ACA was trying to solve a problem,” Nichols said. “Health care and health insurance cost too much. Also, they agree the ACA was a ‘disaster,’ except for the parts everybody liked. Who knew the ACA was this complicated to fix?”

He explained that most of the more than 20 million people who gained health insurance coverage gained it through Medicaid, which is a “problem politically” as Medicaid is the largest item in most state budgets. The marketplaces are working well in some places but not in others, and insurers are pulling out of the marketplaces. And roughly 4 million Americans were satisfied with their health insurance coverage before the mandates and risk pooling.

“Even when everyone agrees upon the goals, health policy is hard,” he continued. “The ACA is far from perfect, and given enough time I can give you all of its flaws. But it is a step toward making access to health care affordable for all Americans…. I would say 85 percent of the opposition to the ACA has nothing to do with health policy. It has everything to do with your philosophy for the role of government.”

The bipartisan repeal-and-replace plans have a few factors in common. For the most part, they fund the cost-sharing reduction payments, strengthen reinsurance to lower premiums, restore outreach and enrollment funds, fix special enrollment period incentives, encourage flexibility, and preserve coverage gains. Nichols’ predictions for health reform are that SCHIP will be reauthorized, small-group practices will be exempt from MACRA for one more year, and the tax reform/cut debate will intensify pressure to cut federal health care spending. There are also bargaining chips on the table with the debt ceiling and hurricane relief.

The second health reform-focused talk was the keynote, “Should Health Care Institutions be the Epicenter for Health?” with speaker Patricia Gabow, MD, former CEO of Denver Health.

She answered four questions: What is health, what is our health care system’s performance, what are the determinants of health and their impact, and what is the way forward to health. She quoted from the World Health Organization: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” She demonstrated that the United States’ health care system ranks low among other developed countries in cost efficiency, coverage and access, quality, and equity and disparity.

“We have significant issues in our health care system’s performance,” Gabow said. “The system also suffers from duplication, fragmentation, misalignment between physicians and patients, etc. The National Academy of Medicine asked why, despite higher expenditures, we have achieved less health. The foci of our investments and incentives are too narrow. They are directed at a biomedical focus.”

“Can the health care system be the entity that broadens our national focus from its current narrow biomedical focus to the broader determinates of health? I think the answer to this is a definite no. There are things we can do about it as physicians: We can be knowledgeable about the current shortfalls of the health care system and educate our leaders about the importance of addressing them. And we can all work with our professional societies to reduce waste and misuse of care, and demand that these savings go not to CEO salaries but to the social determinants of health.”

The third talk on health reform was “State-view Update of Federal Health Care Reform” with Michele Lueck, CEO of the Colorado Health Institute. Her talk held three big takeaways: Half a million Coloradans have health insurance because of the Affordable Care Act, mostly through Medicaid; the Republican repeal-and-replace reform plan benefits younger, richer people at the expense of older, poorer people; and while uncertainty remains, Colorado finds its pragmatic way forward.

“In Colorado we are still struggling with a number of issues, namely high deductibles, high premiums, low competition and regional price differences,” Lueck said. “But we are pragmatic, we are a frontier state, we are just marching right on. You should be proud of the work that’s coming out of the Colorado legislature and ideas that are surfacing out of the governor’s office and lieutenant governor’s office to mitigate these issues.”